1st Set Flashcards
(26 cards)
how much elemental iron should be given daily to correct iron deficiency?
200-300 mg of ferrous elemental iron
Where is iron absorbed?
small intestine. Must give parenteral iron if patient has had small bowel resection
What drug is used to treat acute iron overdose?
deferoxamine. potent iron-chelater. Gives urine a red discoloration. Can cause hypotension and add to cardiovascular stress caused by iron overload.
What drug is used to treat chronic iron overload?
deferasirox. Orally with OJ. Increases serum creatinine and hepatic enzyme levels. Auditory and visual disturbances.
What is the scientific name for Vitamin B12?
cobalamin
What is B12 deficiency most commonly caused by?
malabsorption
What types of foods are rich in B12?
animal products
What type of RBCs would you expect in B12 deficiency? What other findings?
macrocytic, megaloblastic, hypercellular bone marrow, PERIPHERAL NEUROPATHY
Where is B12 abosrbed?
distal ileum
What drugs are used to treat B12 deficiency? are they oral or parentarel?
Cyanocobalamin
AND
hydroxocobalamin - preferred because highly protein-bound and stays in system longer.
Both parentarel because B12 deficiency is usually caused by malabsorption so oral would be pointless.
What drugs can induce folate deficiency? What mechanism?
methotrexate, trimethoprim (antimicrobial), pyrimethamine (antimalarial), Phyenytoin (antiepileptic)
They all attack DHFR to some extent
What is folate deficiency treated with?
leucovorin.
AND
Levomofolate - biologically active form of folate found in circulation. Readily crosses blood-brain barrier.
What does erythropoietin do?
stimulates erythroid proliferation and differentiation.
Induces release of reticulocytes from the bone marrow.
Where is erythropoietin primarily produced?
kidney
What is the driving factor for EPO production?
hypoxia
What are normal EPO levels?
<20 IU/L
What are some serious adverse effects of ESA (erythropoietin stimulating)?
chronic kidney disease if patient has Hgb > 11 g/dL.
Cancer.
Increased risk of DVT (deep vein thrombosis)
What is epoetin alfa?
agonist of EPO receptors expressed by RBC rpogenitors. IV admin. Can cause hypertension, thrombosis, pure red cell aplasia. Try to keep Hgb < 12 g/dL
What is darbepoetin alfa?
long-acting ESA administered weekly
What is methoxy polyethylene glycol-epoetin beta?
long-acting form administered 1-2 times/month. Can not use to treat anemia from cancer chemo because it kills.
What is G-CSF filgrastim?
granulocyte-macrophage colony stimulating factor. Stimulate G-CSF receptors on neutros and progenitors. Useful to treat neutropenia, aplastic anemia, preventing anemia in chemotherapy. Subcutaneous. Causes bone pain upon discontinuation and SPLENIC RUPTURE rarely.
Secondary use - mobilizes hematopoietic stem cells to peripheral blood, where they can be collected for PBSC
What is pegfilgrastim?
long acting form of filgrastim
What is sargramostim?
GM-CSF. Myeloid growth factor that stimulates prolif and iff of early and late granulocytic progenitors, erythroids, and megakaryocytes. Similar to G-CSF, but more likely to cause fever arthralgia, myalgia, and capillary leak syndrome
Is G-CSF filgrastim useful to help treat neutropenia caused by chemo?
yes, but it does NOT improve patient survival.
